Chicago Tribune - April 20, 2003
Shia Kapos, Tribune staff reporter

A compromise reached by lawmakers in Springfield would make HIV testing routine for infants born to mothers who have not taken an HIV test themselves.

Doctors believe this could save lives because advances in medicine now let doctors identify HIV within minutes, allowing them to begin treatments that can prevent infections in babies that not long ago would have seemed inevitable.

But the compromise falls short of requiring that mothers be routinely tested, something that the Centers for Disease Control and Prevention and doctors across the state believe would be an even more-effective way to save babies from HIV infection and improve the outcomes for infected mothers, as well.

"It's a weak bill," said Robert Murphy, director of clinical research for HIV/AIDS at Northwestern University's Feinberg School of Medicine. "It goes against the best public health measures that are recommended."

The measure is moving forward, nonetheless, supported by many doctors and civil libertarians who oppose mandatory testing. The civil libertarians are comfortable with the measure because it requires counseling but allows women to reject the test.

"Studies show that when you counsel women, they agree to be tested," said Ann Fisher, executive director of the AIDS Legal Council.

Many doctors are betting on that, adding they can live with the compromise because it allows immediate care of infants who, with improved medicine, may be able to beat the disease if drugs are administered within 48 hours of birth.

A child has a much better chance, however, if the mother is tested and treatment begins while the child is in the womb.

The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists cite statistics that show HIV transmission can be prevented 99 percent of the time if the mother is tested and drugs are administered prenatally.

Odds worsen after birth

If a child is tested after birth, the odds of preventing infection drop tremendously.

"If you wait until the baby is born, you may have waited too long," Murphy said.

Pregnant women who test positive for HIV and who take oral or intravenous antiretroviral therapy such as nevirapine, AZT and 3TC can reduce the chance of transmission to their child to 8 percent, doctors say. The likelihood could be nearly eliminated if the child, too, then receives drugs within 48 hours of birth.

An HIV-positive woman who waits until delivery to receive the drugs puts her child at a 12 to 15 percent risk of getting the virus. A baby who tests positive for HIV and is born to a mother who never was given treatment has a 30 percent chance of getting the virus.

"You get blood drawn anyway as part of any prenatal care," said Dr. Daniel Johnson, chairman of the Department of Pediatrics at Mt. Sinai and head of the hospital's pediatric and adolescent HIV program. "Adding another teaspoon of blood to be drawn is not an inconvenience. And it provides information that could be lifesaving for a mother and a newborn."

Several other states offer various forms of testing to pregnant women with the right to decline. Only New York and Connecticut have adopted mandatory newborn testing for HIV.

The Illinois bill, which has received overwhelming Senate approval and heads to the House next week, would require HIV counseling of pregnant women and offer an HIV test. That is called an "opt in" policy and one the Centers for Disease Control and Prevention says doesn't work as well as an "opt out" rule, which makes prenatal HIV testing automatic unless a woman signs a form rejecting it.

Doctors say an "opt in" policy will scare patients away.

"Some won't undergo [the test] if they have to sign a form," Johnson said. "Since we know they acquired HIV from sexual contact or contact with blood and therefore it can be paraphernalia for intravenous drug abuse, it opens up personal questions about their lifestyle that people don't want to share with anyone," he said.

The proposal would routinely give newborns an HIV test when their mothers' status is not known. Those tests would be automatic unless the mother signs a form declining the test.

Civil libertarians had worried that a mandatory HIV test would infringe on a woman's right to decide the treatment for her and her baby and could drive away patients who might fear that a positive test would become public.

Now, they are satisfied with the bill headed to the House.

"My primary concern is to ensure that newborns who may be infected with HIV have prospects of survival. Assuring that that happens needs to take into account the authority of parents to consent on behalf of their child for any medical procedure," said state Sen. Barack Obama (D-Chicago), a constitutional law professor at the University of Chicago and co-sponsor of the bill.

AIDS activists, who have traditionally opposed mandatory HIV testing, also like the bill because it requires counseling, which they consider tantamount to fighting the disease.

Assumptions are the problem

"The problem is when doctors look at a pregnant woman and make an assumption that she is not at risk and so they don't bring up the messy topic of HIV," Fisher said.

She pointed to mothers like Jane, a Chicago suburban mother of three who did not fit a stereotype demographic of being susceptible to the AIDS virus.

In 1998, when Jane's then 3-month-old son was hospitalized for pneumonia, he also was diagnosed with HIV.

"Then and only then was I counseled to be tested for the virus," said the 39-year-old mother, who learned then that she had unknowingly carried the AIDS virus. She asked that her full name not be used. "I would have loved to know back then that I could have done something about it. But I wasn't given that chance."

Many Illinois doctors would like to see a law that makes HIV testing as routine as syphilis testing during prenatal care, but they like the bill because it focuses on combating the virus in children.

In Illinois, 50,000 newborns are born each year to mothers whose HIV status is unknown, according to Children's Memorial Hospital. Of those, 150 to 200 will test positive for the presence of HIV antibodies.

Infants are not automatically infected if a mother is HIV positive, doctors say. But the virus can be passed from mother to child during pregnancy, delivery or after delivery during breast-feeding if a mother is not identified as being HIV positive.

A rapid HIV test, a blood test that gives results within half an hour, can be given anytime during pregnancy, delivery or after birth, though doctors say time is of the essence once a baby is born.

"Babies are being born with HIV, and they don't have to be," said Susan Hayes Gordon, public policy officer of Children's Memorial Hospital, which helped write the legislation. "Babies deserve to be born without HIV, and we have the therapy to do it."

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